More than just paracetamol

Headaches are a universal human experience that can be disabling.1 Because they occur often, it is important to be familiar with the main types of headache and their management.

Headaches are described as being either primary or secondary. Primary headaches include migraine, cluster, and tension-type headaches; they have no underlying causes that are readily identifiable. Clinical diagnoses, therefore, are based on features in the history, such as those defined by the International Headache Society (boxes 1 to 4).1 Secondary headaches are related to specific conditions (box 5).

Acute cluster headaches escalate to maximum pain within 15 minutes: drugs which act fast are needed. Inhaling 100% oxygen terminates 70% of attacks within 10 minutes and 90% within 15 minutes.7 Patients may keep a supply at home to treat their attacks. A 6 mg subcutaneous injection of sumatriptan, or intranasal administration, is equally effective. 2